NPIMap

Individual provider Active NPI

Brenda R Larson, MD

  • Hematology & Oncology Physician
  • St Louis Park, MN
National Provider Identifier
1952310237
Registry record updated Apr 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
48944 Issued in MN
Practice address
3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone
(952) 993-3248
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 48944 MN Primary

Addresses

Primary practice location

3931 Louisiana Ave S
St Louis Park, MN 55426-5000

Mailing address

8170 33Rd Ave S
PO Box 1309 Mail Stop 21110Q
Minneapolis, MN 55425-4516

Other identifiers 4

IdentifierTypeStateIssuer
652600000MedicaidMN
35216700MedicaidWI
ENROLLEDMedicaidIA
P00391392OtherMNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060906000156 MN Practitioner - Hematology/OncologyPractitioner - Internal Medicine 9830193838 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
University of Minnesota Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • St Francis Regional Medical Center Hospital, Shakopee, MN, CCN 240104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Current Accepting new patients
Park Nicollet Clinic CurrentSince Aug 1, 2009 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Aug 1, 2009 Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

3931 Louisiana Ave S
St Louis Park, MN 55426
Phone (952) 993-3230

Interoperability endpoints

  • Direct secure messaging: blarson98802@excellian.direct.allina.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460505600000",
    "number": "1952310237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "PO BOX 1309 MAIL STOP 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3931 LOUISIANA AVE S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554265000",
            "telephone_number": "952-993-3248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "BRENDA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2016-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MN",
            "license": "48944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "652600000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35216700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00391392",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.